You
will be able to view copies of each of your pay stubs for the current calendar
year and in the future you will be able to view your latest W-2
information. The electronic
stub will not show your social security number, nor will it have your home
address. The information will only
be available to you using a user ID and a password that will be issued to you.
Please
respond yes that you would like to have your pay stub on-line access to
the Internet. Before responding
yes make sure you have access to the Internet either at work or at home.
If you
do not want your pay stub on-line then respond no. You will then continue receiving a hard
copy of your pay stub.
[ ] YES,
I would like to receive my pay stub electronically via the Internet.
[ ] NO,
I do not want to receive my pay stub via the Internet. I want to continue receiving a hard copy of my pay stub.
You may have more than one direct deposit
request. I hereby authorize ITD to
initiate credit entries and to initiate, if necessary, debit entries and
adjustments for any credit entries in error to my account indicated below and
the depository name(s) below, hereinafter called depository, to credit and/or
debit the same as such:
NAME: __________________________________________
______-____-______
(Please print your name as it appears
on your account) (Social Security #)
ACCOUNT TYPE: ___ Checking ___ Savings
AMOUNT: $____________________
BANK: ___________________________________
ACCOUNT #:_____________________ BANK ROUTING #:_____________________
ACCOUNT TYPE: ___ Checking
___ Savings AMOUNT:
$____________________
BANK: ___________________________________
ACCOUNT #:_____________________ BANK ROUTING #:_____________________
EMPLOYEE SIGNATURE: ______________________________ DATE:
_______________
The authority is to remain in full force and
effect until the agency has received written notification from me of its
termination in such time and in such manner as to afford the company and
depository a reasonable opportunity to act on it.
___ Return the completed form to the Human Resources Department or Local
Personnel Technician.
___ Your direct deposit should begin within two pay periods after we receive
your completed form.